Infections Of Upper Airways Research Articles

Unusual manifestations of premenstrual syndrome

The authors have identified six unusual manifestations of premenstrual syndrome: (i) typical premenstrual dysphoric disorder symptoms during ovulation; (ii) upper airway infection in the premenstrual phase that remits after onset of menstruation; (iii) recurrent perimenstrual erythematous and edematous skin plaques; (iv) hypomanic or manic state 2-3 days before onset of menstruation; (v) auditory hallucinations and delusion of reference, present only premenstrually; and (vi) remitted bipolar disorder presenting with premenstrual psychotic features. Psychiatrists should be aware of menstrual cycle-related changes in mental illness, physical illness, or both in women of reproductive age, if cyclic trends are suspected.

喉頭蓋膿瘍５例の検討

Severe airway stenosis due to acute upper airway infection is an emergent situation. Without prompt and appropriate treatment, the outcome may be fatal.During the period from November 2005 to October 2006, we treated five epiglottic abscess patients. We examined the occurrence factors and their clinical courses. We divided these patients into two groups regarding their postoperative clinical courses in order to examine the retrospective necessity of tracheostomy.One case had diabetes and chronic renal failure, but the other four had no past illness which might reduce immune function. We experienced two cases who showed advanced epiglottic abscess in spite of conservative therapy against epiglottitis.We performed surgical drainage and tracheostomy in all five patients. Although upper airway stenosis improved satisfactorily after operations in two of the five (group I), epiglottic swelling was exacerbated again on the day following the operation compared with the epiglottic thickness immediately after the operation in the other three (group II). We investigated clinical differences between the two groups, and found that both the value of CRP and number of WBC in group II on the day when abscess diagnosis was made had a tendency to be higher compared with those in group I. And the number of hospitalization days of group II also had a tendency to be longer than that of group I.Epiglottic abscess runs a risk of suffocation. In contrast, patients generally convalesce satisfactorily with appropriate airway management. Accurate diagnosis and prompt treatment are thought to be essential.

Maturation of cough and other reflexes that protect the fetal and neonatal airway

Although aspiration of contaminated amniotic fluid and gastric contents is common at birth, anecdotal evidence indicates that coughing occurs rarely if at all. Studies in which cough and other airway protective responses have been stimulated by introducing a small bolus of water or saline into the pharynx of sleeping infants have found that the predominant responses are swallowing, apnea and laryngeal closure. Coughing is rare. Collectively, these responses are known as the laryngeal chemoreflexes (LCR). These are mediated by receptors in the inter-arytenoid space. The LCR has been studied extensively in animal models. Upper airway infection increases the responses and in this case coughing becomes a common component. Studies in animal models indicate that with maturation, apnea and swallowing components of the LCR decrease while cough becomes increasingly prominent.

Intranasal immunization with phosphorylcholine induces antigen specific mucosal and systemic immune responses in mice

Phosphorylcholine (PC) is a structural component of a wide variety of pathogens including Streptococcus pneumoniae and Haemophilus influenzae, and anti-PC immune responses are known to protect mice against invasive bacterial diseases. The present study tested the capability of PC as an intranasal plurispecific vaccine against upper airway infections. BALB/c mice immunized with intranasal PC-keyhole limpet hemocyanin (KLH) plus cholera toxin (CT) as a mucosal adjuvant showed increased PC-specific IgM in serum, IgA in nasal wash and saliva, and numbers of PC-specific nasal and splenic antibody producing cells. Enhanced production of IL-4 and IFN-γ by CD4 + T cells indicated the participation of Th2- and Th1-type cells. Salivary IgA antibodies produced by intranasal immunization with PC-KLH plus CT reacted to most strains of S. pneumoniae and H. influenzae. Further we demonstrated that the clearance of S. pneumoniae and H. influenzae from the nasal tract was significantly enhanced by nasal immunization with PC-KLH and CT. Thus, intranasal vaccination to induce PC-specific immune responses might help to prevent upper airway infections caused by S. pneumoniae and H. influenzae.

Recurrent upper airway infections and bacterial biofilms

Bacterial biofilms identified in various medical devices used in otorhinolaryngology, including tympanostomy tubes, voice prostheses, and cochlear implants, can directly colonise mucosal tissues. The upper airways seem to be at high risk for this type of colonisation. Chronic and/or recurrent upper airway infections may be related to the complex structural and biochemical (quorum sensing) organisation of the biofilm which interferes with the activity of antibiotics (including those with proven in vitro efficacy), thus promoting the establishment of a chronic infection eradicable only by surgical treatment. Biofilm formation plays a role in upper respiratory infections: it not only explains the resistance of these infections to antibiotic therapy but it also represents an important element that contributes to the maintenance of a chronic inflammatory reaction. To document the presence of biofilms in surgical tissue specimens from patients with recurrent infection diseases, and identify their possible role in the chronicity of these infectious processes. We examined 32 surgical specimens from the upper respiratory tract (tonsils, adenoids, mucosa from the ethmoid and maxillary sinuses) of 28 patients (20 adults, eight children) with upper airway infections that had persisted despite repeated treatment with anti-inflammatory agents and antibiotics with demonstrated in vitro efficacy. Tissues were cultured using conventional methods and subjected to scanning electron microscopy for detection of biofilm formation. Over 80 per cent (26/32; 81.3 per cent) of the tissue specimens were culture-positive. Bacterial biofilms (associated in most cases with coccoid bacteria) were observed in 65.6 per cent of the tissue samples.

Cervical infection with descending mediastinitis: a review of six cases

The aim of this study was to retrospectively review cases of cervical infection with descending mediastinitis, and to analyse the clinical character, diagnosis and treatment of this infection. Six patients were identified from December 1998 to June 2005. Their aetiology, associated systemic diseases, bacteriology, radiology, treatments and outcomes were reviewed. Four cases resulted from odontogenic infection, one from upper airway infection, and one had an unknown cause. Diffuse swelling in face and neck, chest distress, tachypnea, and fever were the main symptoms. Chest radiography showed a widening of the upper mediastinal shadow in four patients. Four patients underwent computed tomographic scanning that confirmed the diagnosis of descending mediastinitis, which suggests that routine use of this scan be highly recommended for early detection. Six different pathogens were identified through pus and blood culture. All patients underwent surgical drainage. Three patients received a tracheotomy. Of the six patients, four achieved good results, and there were two deaths. Early surgical drainage remains the main treatment for cervical infection with descending mediastinitis. Delayed diagnosis, inadequate drainage and multidrug-resistant bacterial infection were responsible for the deaths.

Changing Epidemiology of Life-Threatening Upper Airway Infections: The Reemergence of Bacterial Tracheitis

As a consequence of evolving medical practice, the epidemiology of potentially life-threatening upper airway infections is changing. We report our experience over 9 years with viral croup, epiglottitis, and bacterial tracheitis. We studied a retrospective case series of patients admitted to Vermont Children's Hospital with potentially life-threatening upper airway infections viral croup, epiglottitis, or bacterial tracheitis between 1997 and 2006. There were 107 patients with viral croup admitted to Vermont Children's Hospital, with 16 (15%) admitted to the pediatric intensive care unit. Three patients with croup (17% of pediatric intensive care unit admissions, 3% of total admissions) required intubation. There were no serious complications. Eighteen patients were admitted with bacterial tracheitis. Ninety-four percent (n = 17) were admitted to the pediatric intensive care unit. Eighty-three percent (n = 15) were intubated. Twenty-eight percent of patients (n = 5) developed serious complications. Two adolescent patients were admitted with epiglottitis. Both were intubated and recovered without complications. Of 35 patients admitted to the pediatric intensive care unit with these potentially life-threatening upper airway infections, 20 patients (57%) developed respiratory failure. Fifteen patients (75%) had bacterial tracheitis, 3 patients (15%) had viral croup, and 2 patients (10%) had nonclassic epiglottitis. Immunization against Haemophilus influenza type b and widespread use of corticosteroids for the treatment of viral croup have changed the epidemiology of acute infectious upper airway disease. As potentially life-threatening infections, viral croup and epiglottitis have been eclipsed by bacterial tracheitis. In this series, bacterial tracheitis was 3 times more likely to have caused respiratory failure than viral croup and epiglottitis combined. Bacterial tracheitis should be considered in children who present with acute life-threatening upper airway infection.

O.440 Speech outcome after two different surgical approaches for palate repair

Various aspects have been proposed as the cause of otitis media with effusion (OME) in cleft lip and/or palate (CL/P) populations (i.e. abnormal anatomic relation of Eustachian tube (ET) musculature and soft palate; the lack of intact palatal partition; reduction of nasal patency or chronic rhinitis; timing and type of surgery). However, the role of deviated craniofacial skeleton (CFS) in CL/P has been neglected, although the role of the craniofacial development on poor ET function has been advocated in non-cleft children. In this study, we evaluated clinical and cephalometric data of 37 Japanese children with unilateral complete cleft lip and palate (UCLP, 25) or isolated cleft palate (ICP, 12) and compared them to 40 non-cleft children, who were proportionally matched for age and sex. Data showed that OME was more often in children with unilateral cleft lip and palate-UCLP (76%) and those with isolated cleft palate-ICP (67%) than non-clefts (10.00%). In addition to a number of skeletal abnormalities (i.e. short dimensions related to the posterior cranial base and backward and upward position of the maxilla) detected in CL/P cases, mastoid depth and height were also shorter in cleft cases than normal subjects. On the other hand, a small tendency to recurrent upper airway infection (RUAI) was observed in cleft cases with OME. Further, it was found that the following differences in the mastoid-middle ear-Eustachian tube (M-ME-ET) system were associated with a tendency to OME in UCLP cases: more horizontal ET in relation to the posterior cranial base; short bony ET; short height and antero-posterior depth of the mastoid air cell system.

Deep Neck Infections: A Constant Challenge

Background: Although the advent of antibiotics and improved dental care decreased the incidence and mortality, deep neck infections (DNIs) are not uncommon and present a challenging problem due to the complex anatomy and potentially lethal complications that may arise. Objectives: This study reviews our experience with DNIs and tries to identify the predisposing factors of life-threatening complications. Methods: A retrospective review was conducted of patients who were diagnosed as having DNIs in the Department of Otolaryngology and in the Department of Infectious Diseases at Treviso Regional Hospital from 1995 to 2003. Associations between life-threatening complications and other factors were determined by χ² test, Fisher’s exact test and Student’s t test as appropriate. Results: One hundred sixty-seven charts were recorded; 95 (56.9%) were men, and 72 (43.1%) were women, with a mean age of 49.6 ± 20.4 years (range: 2–96). There were 39 patients (23.4%) who had associated systemic diseases, with 53.8% (21/39) of those having diabetes mellitus. The lateral pharyngeal and submandibular spaces were the most commonly involved spaces. Upper airway infections and odontogenic infections were the two most common causes of DNIs (47.5 and 27.9% of the known causes, respectively). The pathogenesis remained unknown in 45 patients (26.9%). Coagulase-negative staphylococcus (36.9%) and Streptococcusviridans (28.8%) were the most common organisms, identified through cultures. Of the abscess group (77 patients), 42 patients (54.5%) underwent surgical drainage under general anesthesia. Thirty-one patients (18.6%) developed life-threatening complications: airway obstruction (n = 18), descending mediastinitis (n = 6), jugular vein thrombosis (n = 4), and pneumonia (n = 3). Compared with other patients, the unique features of patients with life-threatening complications were as follows: older age (p = 0.04), a higher white blood cell count (p = 0.01), abscess formation (p = 0.02), associated systemic disease (p < 0.001), diabetes mellitus (p < 0.001), anterior visceral space involvement (p < 0.001), and multiple-space involvement (p < 0.001). Conclusions: DNIs continue to occur and these are associated with significant morbidity and mortality even in this era of antibiotics. Furthermore, the widespread and inappropriate use of antibiotics may change the clinical presentation and course of these infections, making them more elusive and less predictable also in complicated cases. The clinical assessment of patients who are older, with abscess formation, underlying systemic diseases, diabetes mellitus, visceral anterior space or multiple-space involvement requires careful consideration of potential complications.

Variação sazonal nos atendimentos de emergência por asma em Gama, Distrito Federal

To quantify the number of asthma attacks treated in the emergency room of a public hospital and to study seasonal fluctuations, taking into consideration the local climate, which is characterized by having only two seasons: a rainy/humid season and a dry season. A retrospective survey was conducted in a community general hospital. A total of 37,642 emergency room consultations related to asthma, bronchitis, pneumonia, upper-airway infection or other respiratory complaints were registered during a two year period. The data from each patient chart were collected for later analysis. Among the respiratory conditions treated, asthma (24.4%) was the second most common diagnosis. Most of the asthma consultations (56.6%) involved children below the age of fifteen. Regression analysis revealed a seasonal variation in the number of asthma consultations, which was significantly higher in March (p = 0.0109), the low points being in August (p = 0.0485) and September (p = 0.0169). The correlation between climate and asthma was most significant in relation to changes in humidity, although the effect was delayed by one month (p = 0.0026) or two months (p = 0.0002). Visits to the emergency room for the treatment of asthma attacks were more frequent during the rainy season, increasing at one to two months after the annual increase in humidity and decreasing in the dry season. This positive correlation raises the possibility of a causal relationship with proliferation of house dust mites and molds.

Tratamiento de la infección periamigdalina

To evaluate the clinical and epidemiologic characteristics in children with peritonsillar infections. A longitudinal retrospective study was performed through a review of the clinical histories of patients attending the emergency unit in the previous 6 years. The variables gathered were age, sex, recurrent tonsillitis, previous upper airway infection, antibiotic administration, and therapeutic approach. Twenty-nine children were admitted, with a mean age of 7.4 +/- 1.6 years (boys 1.6:1). Twenty-seven percent had recurrent tonsillitis. At the visit, 57.8 % had an upper respiratory infection and 65 % were taking antibiotic treatment, especially macrolides. The treatment selected at our center consisted of the association of penicillin or amoxicillin-clavulanate acid with clindamycin, including corticosteroids. Ten children underwent computed tomography and nine underwent fine-needle aspiration. Drainage was performed in 20.6 % of confirmed abscesses. The mean length of hospital stay was 5.6 +/- 1.6 days. Delayed tonsillectomy was performed in 31 %, except in one patient who developed a parapharyngeal abscess. Currently, 18.9 % of all peritonsillar infections occur in the pediatric population. The increase in these infections is probably related to inappropriate use of antibiotics in respiratory diseases. Diagnosis is clinical, and infections are often resolved by intravenous administration of beta-lactams with clindamycin and an expectant attitude. When an abscess is suspected or there is no clinical improvement, fine-needle aspiration or computed tomography is warranted and drainage should be performed if an abscess is confirmed. Tonsillectomy, usually delayed, is only indicated in patients with recurrent tonsillitis.

DECH crônica: fator preditivo para rinossinusite no transplante de medula óssea

INTRODUÇÃO: transplante de medula óssea (TMO) é uma opção de tratamento para doenças hematológicas, tumorais e imunodeficiências e tem sido realizado com maior freqüência. O TMO predispõe a infecções de VAS e complicações, dentre estas as rinossinusites (RS). Quimioterapia, radioterapia, infecções virais, antibioticoterapia e doença do enxerto versus hospedeiro (DECH) são fatores predisponentes para RS. OBJETIVO: Verificar freqüência das RS no TMO e relação com DECH. Tentar estabelecer qual melhor tratamento para as RS no TMO. MÉTODO: Avaliação otorrinolaringológica de 2 grupos com 35 (gI) e 24 (gII) pacientes, antes e depois do TMO; e tratados individualmente com antibióticos e/ou punção de seios maxilares e/ou sinusectomia endoscópica. RESULTADOS: Nenhum apresentou RS antes do TMO; 42,8% dos TMO do gI tiveram RS e 34%, DECH; enquanto 58% do gII tiveram RS e 25%, DECH. No total, 49% tiveram RS e 30,5% com DECH. Houve significativa maior freqüência de RS em DECH crônica. A cirurgia foi indicada para tratamento de RS no TMO com DECH crônica. CONCLUSÃO: A freqüência de RS no TMO foi de 49%; DECH crônica é um fator predisponente para RS; a sinusectomia pode ser necessária nos pacientes com DECHc e RS.

Chronic GVHD: predictive factor for rhinosinusitis in bone marrow transplantation

SummaryIntroductionBone marrow transplantation (BMT) is a treatment option for hematological diseases and immunodeficiency. It is frequently used today. BMT predisposes patients to upper airway infections and its complications, such as rhinosinusitis (RS). Chemotherapy, radiotherapy, viral infections, antibiotic therapy, graft versus host disease (GVHD) are rhinosinusitis predisposing conditions.Aimto investigate RS frequence in this population and its relationship to GVHD; to try and establish the best treatment for RS in these patients.MethodENT evaluation of two groups. One group with 35 patients (gI) and another with 24 patients (gII), before and after BMT. They were treated with antibiotics, maxillary sinus punction or endoscopic sinusectomy.Resultsnone of them had RS before BMT. 42.8% from gI had RS and 34% had GVHD; in the gII, 58% had RS and 25% had GVHD. 49% from both groups had RS and 30.5% had GVHD. There was significantly more RS in chronic GVHD patients. Surgery was used to treat RS in chronic GVHD patients who underwent BMT.ConclusionRS frequence was 49%; GVHD is a predisposing condition to RS; sinusectomy may be necessary to control RS in GVHD patients.

Systematic literature review of modifiable risk factors for recurrent acute otitis media in childhood

Review evidence about modifiable risk factors for recurrent acute otitis media. MEDLINE with no language restriction, from January 1966 to July 2005, using descriptors "acute otitis media/risk factors". Two hundred and fifty-seven articles were obtained. These included randomized clinical trials, cohorts, case-control and cross-sectional studies that contained analyses of modifiable risk factors for the development of recurrent acute otitis media as the main objective and with samples of individuals up to the age of 18 years. Except when relevant, the following were excluded: non-systematic reviews, reports of cases, series of cases, and medical society guidelines. Nine risk factors linked to the host and eight linked to the environment were identified. Of the first group, allergy, craniofacial abnormalities, gastroesophageal reflux and the presence of adenoids were classified as modifiable. In the second category, upper airway infections, day care center attendance, presence of siblings/family size, passive smoking, breastfeeding and use of pacifiers were included. Afterwards, the risk factors were classified in accordance with levels of evidence. The risk factors established for recurrent acute otitis media and capable of being modified were the use of pacifiers and care in daycare centers. The probable risk factors were privation of mother's milk, presence of siblings, craniofacial abnormalities, passive smoking and presence of adenoids. No modifiable factor was classified as unlikely. Among those that need further study are allergy, gastroesophageal reflux and passive smoking during gestation.

Fatores de risco para otite média aguda recorrente: onde podemos intervir? - uma revisão sistemática da literatura

OBJECTIVE: Review evidence about modifiable risk factors for recurrent otitis media. SOURCE OF DATA: MEDLINE with no language restriction, from January 1966 to July 2005, using descriptors acute otitis media/risk factors. Two hundred and fifty-seven articles were obtained. These included randomized clinical trials, cohorts, case-control and cross-sectional studies that contained analyses of modifiable risk factors for the development of recurrent otitis media as the main objective and with samples of individuals up to the age of 18 years. Except when relevant, the following were excluded: non-systematic reviews, reports of cases, series of cases, and medical society guidelines. SUMMARY OF DATA: Nine risk factors linked to the host and eight linked to the environment were identified. Of the first group, allergy, craniofacial abnormalities, gastroesophageal reflux and the presence of adenoids were classified as modifiable. In the second category, upper airway infections, day care center attendance, presence of siblings/family size, passive smoking, breastfeeding and use of pacifiers were included. Afterwards, the risk factors were classified in accordance with levels of evidence. CONCLUSIONS: The risk factors established for recurrent otitis media and capable of being modified were the use of pacifiers and care in daycare centers. The probable risk factors were privation of mother's milk, presence of siblings, craniofacial abnormalities, passive smoking and presence of adenoids. No modifiable factor was classified as unlikely. Among those that need further study are allergy, gastroesophageal reflux and passive smoking during gestation.

Mesangial IgA deposition in minimal change nephrotic syndrome: coincidence of different entities or variant of minimal change disease?

Mesangial deposition of IgA (MCA) is a very rare finding in minimal change disease and has previously been considered a pure coincidence. In the U.S. and Europe only anecdotal case reports exist. To date, there has been no consensus on nomenclature and categorization of this entity. We describe 2 cases of MCA with analogue histological findings but relevant differences in clinical presentation, and we discuss the clinical implications of mesangial IgA deposition in minimal change nephrotic syndrome. A 47-year-old female was admitted to hospital with nephrotic syndrome, microscopic hematuria, arterial hypertension and slight impairment of renal function 3 weeks after an unspecific upper airway infection. A 42-year-old male presented with nephrotic syndrome, microscopic hematuria, normotension and normal renal function. Both of the nephrotic syndromes were steroid-responsive and steroid-dependent. The clinical presentation of the male patient was consistent with the features of minimal change glomerulopathy, whereas the female patient combined signs of minimal change disease and IgA nephropathy. Light microscopy revealed mesangial IgA immune deposits and slight mesangial hypercellularity. Electron microscopic studies of MCA patients disclose diffuse effacement of glomerular foot processes. Our cases and a review of the literature indicate that the histological diagnosis of MCA may comprise different pathogenetic entities. From the clinical point of view, MCA has to be regarded as a minimal change nephrotic syndrome with symptomatic or asymptomatic mesangial IgA deposition. IgA deposition constitutes a risk factor for impairment of renal function and indicates a frequently relapsing course.

Factors affecting the bacteriology of deep neck infection: a retrospective study of 128 patients

Conclusions. Broad-spectrum antibiotics are advocated for treating deep neck infection. Anaerobic coverage is necessary, especially in odontogenic cases. The presence of diabetes, infection of the parotid space and an obvious odontogenic source of infection can aid in determining the causative organisms. Objectives: This study aimed to analyze the bacteriology in deep neck infections and identify the factors that influenced the causative pathogens.Materials and methods. The records of 212 patients who were diagnosed as having deep neck infections at the National Taiwan University Hospital between 1997 and 2003 were reviewed; 128 patients with bacterial isolation from their pus cultures were enrolled.Results. The cultures of 46 patients (35.9%) were polymicrobial. Viridans Streptococcus was the most commonly isolated organism (38.3%), followed by Klebsiella pneumoniae (32.0%) and Peptostreptococcus (17.2%). The most common organism in 44 diabetic patients was K. pneumoniae (54.5%), versus viridans streptococcus (48.8%) in 84 nondiabetic patients. In patients with dental sources of infections, the culture rate of anaerobes was 59.3%; in upper airway infections and other sources of infections they were 22.7% and 21.5%, respectively (χ2 test, p = 0.0008). The differences in age, sex, and climate did not show any significant changes in the common causative pathogens. Common pathogens in the infection of parapharyngeal, submandibular, and extended spaces were the same as viridans streptococcus, but in the parotid space K. pneumoniae was the most common pathogen.

Changes in the epidemiology of epiglottitis following introduction of Haemophilus influenzae type b (Hib) conjugate vaccines in England: a comparison of two data sources

Paediatric cases of epiglottitis declined markedly in England following the introduction of safe effective immunization against Haemophilus influenzae type b (Hib). With the recently described resurgence in Hib infections, a corresponding rise in the number of presentations of clinical epiglottitis in children was observed, although numbers were still well below those reported prior to vaccine availability. This was seen both in microbiology reports and hospital admissions data for England. In keeping with the more diverse aetiology of epiglottitis in adults, Hib vaccination had minimal impact on hospital presentations with upper airway infections in those aged 15 years and over, which showed an overall increasing trend over 10 years. The need for a high index of suspicion to allow early diagnosis of this life-threatening clinical presentation is reinforced.

Galacto-oligosaccharides and long-chain fructo-oligosaccharides as prebiotics in infant formulas: A review

The present review summarizes clinical and experimental data concerning the possible effects of a prebiotic mixture of short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides. The results from several studies, made up of over 400 preterm and term infants, clearly demonstrate that the prebiotic mixture under examination specifically stimulates the growth of bifidobacteria and lactobacilli and reduces the growth of pathogens. As a consequence of the changed intestinal flora by the dietary galacto-oligosaccharides and fructo-oligosaccharides, the faecal pH values and the short-chain fatty acid pattern were similar to those found in breastfed infants. In addition, the stool consistency was the same as in breastfed infants. In vitro experiments have demonstrated that the specific short-chain fatty acid pattern, at a pH similar to that found in faecal samples of breastfed infants, reduces the growth of pathogens in a dose-dependent manner but does not influence the growth of bifidobacteria and lactobacilli. In an animal vaccination model, the prebiotic mixture improved the response to vaccination. In an allergy model (sensitization by ovalbumin), the allergic reaction was reduced by the prebiotic mixture. The data obtained from animal experiments are in agreement with preliminary data from clinical trials which indicate a reduced allergic response (reduced plasma IgE/IgG4 ratio) and reduced episodes of upper airway infection during the first year of life.Experimental evidence demonstrates that the prebiotic mixture employed in these studies modulates the intestinal flora and modulates the immune system as human milk does. There are sufficient experimental data to put forward the hypothesis that substances like the prebiotic mixture under study will substantially contribute to the improvement of the protective properties of infant formulas.

Galacto‐oligosaccharides and long‐chain fructo‐oligosaccharides as prebiotics in infant formulas: A review

The present review summarizes clinical and experimental data concerning the possible effects of a prebiotic mixture of short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides. The results from several studies, made up of over 400 preterm and term infants, clearly demonstrate that the prebiotic mixture under examination specifically stimulates the growth of bifidobacteria and lactobacilli and reduces the growth of pathogens. As a consequence of the changed intestinal flora by the dietary galacto-oligosaccharides and fructo-oligosaccharides, the faecal pH values and the short-chain fatty acid pattern were similar to those found in breastfed infants. In addition, the stool consistency was the same as in breastfed infants. In vitro experiments have demonstrated that the specific short-chain fatty acid pattern, at a pH similar to that found in faecal samples of breastfed infants, reduces the growth of pathogens in a dose-dependent manner but does not influence the growth of bifidobacteria and lactobacilli. In an animal vaccination model, the prebiotic mixture improved the response to vaccination. In an allergy model (sensitization by ovalbumin), the allergic reaction was reduced by the prebiotic mixture. The data obtained from animal experiments are in agreement with preliminary data from clinical trials which indicate a reduced allergic response (reduced plasma IgE/IgG4 ratio) and reduced episodes of upper airway infection during the first year of life. Experimental evidence demonstrates that the prebiotic mixture employed in these studies modulates the intestinal flora and modulates the immune system as human milk does. There are sufficient experimental data to put forward the hypothesis that substances like the prebiotic mixture under study will substantially contribute to the improvement of the protective properties of infant formulas.